FY17 SRC Family Caregiver Support grant contracttuL 0 6 2016
0R t(;t NA t, ('()N't'RA("t'
CAPE FEAR CO{,]NCIL OF GOVERNMENTS
AREA AGENCY ON AGING
GRANT AGREEMENT FOR
FAMILY CAREGIVER SUPFORT GRANTS
July 1,2016 - June 30, 2017
I. PARTIESTOTHECONTRACT
This agreernent is made and entered into this 276 day of July 2016 between the Cape Fear Council of
Governments (1480 llarbour Drive, lVilmington, NC 28401), hereinafter referred to as the "Council of
Govemments," and New Hanover CounQt Senior Resource Center (2222 South College Rd, llilmington, NC
28403), hereinafter referred to as the "Grantee."
II. EFFECTIVE PERIODOFCONTRACT
This contract shall be effective Juty 1, 2016 and shall terminate on June 30,2017.
III. GENERALPROVISIONS
Subject to the terms and conditions hereinafter set forth, the Council of Governments agrees to gant Family
Caregiver Support Program funds per the NC Division of Aging and Adult Services authorized through the
National Family Caregiver Support Act, (The Older Americans Act, as amended in 2000, Title III, Part E).
This grant is intended to sustain the efforts of families and other informal caregivers ofolder adults by
providing supportive services (as defined below) under the following Category 2 Access to Services,
Category 3 Training, Counseling & Support Groups Category 4 Respite Care, or Category 5 Supplernental
Services. The objective is to give caregivers relief and provide assistance in finding services allowing thern to
keep their older adult in the community for as long as possible and/or help support older adult relatives raising
children I 8 years of age or below . The services covered under the grant are intended for caregiver not
receiving any other assistance.
Category
(2,3,4
or 5)
S€rvlccs
To be
provided
Grant
Amount
Unit Cosr
Ifapplicable
Projected
Number of Units
If Applicable
Projected
#tobe
Seryed
2 (823)Care Management $20 N/A N/A 60
3 (833)Support Groups $ 1,100 N/A N/A nla
4 (842)In-home/non-medical
Resoite (varies)
$20,380 $19.00 1073 36
4 (843)Adult Day Care
Day Health
$ 1,800 $4rlday 47 4
s (8s7)Incontinence Supplies $ 500 8
s (8se)Liquid Nutritional
SuDolemental
$ r00 3
$24,O00
Note: The Cape Fear Council of Governments Area Agency on Aging must approve any changes to the budget.
Category 2 Assistrnce in Gaining Access to Services (individual, one on one contact to assist caregivers in
gaining access to services)
The Grantee has allocated $20 to this category.
Category 3 Training, Counseling and Support Groups
The Grantee has allocated $ I , 100 to Category 3 (33) Support Groups to help with monthly caregiver support
group meetings. They have 4 support groups to assist caregivers.
Category 4 Respite Services (Considered temporary, substitute supports or living arrangernents to provide a brief
period ofreliefto caregivers on an intermittent, occasional or ernergency basis)
*Eligible caregivers must be caring for an older adult 60+ with at least two ADL (Actiities of Daily Living i.e.
eating, dressing, bathing) impairments or individuals with Alzheimer's disease and related disorders with
neuroloeical and orsanic brain dlsfunction. No more than $1500.00 may be ased per eligible client during grant
p*iod.
The grantee has allocated $20,380 to Category 4 (E42) In-IIome Respite and $1,800 to Category a (8a3)
Community Respite'Adult Day Care which will be used to temporarily provide some time offfor caregivers.
These services will be provided for functionally impaired individuals whose primary caregivers need relief from
everyday car€giving responsibilities in order for impaired individuals to rernain at home for as long as possible.
The Grantee will give the caregivers as much choice and flexibility as possible by offering temporary respite
through in-home aide (medical and non-medical), adult day carelday health, group respite, and institutional respite
in a licensed adult carelnursing facility. Referral for these services will be made after asses$nents (including
rwiewing current services that are being provided to care recipient by compl€ting a comprehensive intake form)
are completed and an app, opriate care plan has bem developed by the Grantee.
Category 5 Supplemental Services (Services intended as a one-time assistance to caregivers that compliments the
care they are providing. Examples include: purchasing incontinence supplies, home modifications, home safety
interventions) *Eligible caregivers must be caring for an older adult 60+ with at least two ADL (Activities of Daily
Living i.e. eating, dressing, bathing) impairments. No more lhan $500.00 may be used per eligible client during
grant period.
The Grantee has allocated $600 to Category 5 (857) Incontinence Supplies and $100 to Category 5 (859 Ltquid
Nutritional Supplements to help with the financial burden for caregivers purchases these supplies.
These services are to provide temporary reliefand will be a bridging mechanism until consistent services are
available. The NC Divffion of Aging and Aduh Sewices Home and Communig Care Bloch Grant Semice
Standards will be used lor provided semices. The Family Caregiver Resource Specialist and other AAA staffwill
provide technical assistance for duration of the grant. The terrns se, forth in this ogreement for payment arc
contingent upon availability of funding.
IV. GRANTAMOUNT
The total payment under this contract sha[ not exceed $24,000. The North Carolina Division of Aging and
Adult Services is providing the match for the Family Caregiver Support Program; therefore no local match
is required.
V. DOCUMENTATIONAND COMPENSATION
ln order to qualifu for funding, applicants must agree to comply with the following:
o All required assur.ulces (which state the organization must comply with Section 504 of the Rehabilitation
Act of 1973, as amended (29 U.S.C. 794), the Americans with Disabilities Act of 1990, and the Department
of Health and Human Services Regulation under Title VI of the Civil Rights Act of 1964) must be signed
prior to receipt of funding under the FCSP.
o AErnS Resource Management System 1411145) Requirernents: All program performance and financial
reports must conform to the requirements of the Division of Aging and Adult Services' automated Aging
Resource Managanent System (ARMS). The Grantee will be required to participate in the automated
ARMS by supplying the necessary and required input data. The Grantee will also be required to participate
in appropriate training workshops by the Division of Aging and Adult Services and/or Area Agorcy on
Aging. Failure to comply with the reporting requirernents may result in either withholding of funds or
possible suspension/termination of funding. Grantees are required to participate in the ARMS user's fee.
The fee shall apply to each of the categories as the reimbursements are requested through ARMS. It shall
be based on the following formula:
# of records reimbursernent is _X $ . 1 5 Maintenance cost per service record
Requested for each service budget code
The Service Code is as follows:
Information/Assistance 822
Care Manaqement 823
Support Groups 833
Traininq/Education 83s
In-home ResDite Care 842
Community Respite (Adult Day Care)843
Institutional Respite 845
Medical EquiDment and Assistive Technolmv 854
Home Modifications/Accessibiliw(qrab bars, etc)855
Personal Emeroency ResDonse Systems 855
Incontinence Supplies 857
Liquid nutritional suDDlements (ensure, boost)8s9
Compensation: Grantees must meet the reporting requirernents of the NC Division of Aging and Adult
Services and the Cape Fear Area Agency on Aging Family Caregiver Support Program. Payments will be
made monthly upon request for reimbursement ttrough 4111145 by Grantee. Reimbursement forms will be
due monthly to the Area Agency on Aging and must be received no later than the 7th of each ,nonth in
otder to be considered lor payment at the end of thd month. These forms should reflect the amount of
funds requested through the ARMS each month.
Payment of funds will be based upon the Aging Resource Management System (ARMS) Provider
Reimbursement Report (ZGA370-12). The Cape Fear Council of Govemments will forward payment of
the approved budget expenditure at the end of each month.
Documentation of Expenses: Grantee shall maintain full and complete documentation of all expenses
associated with performing the scope of work under this contract. Documentation in the form of time
sheets or other verification (prior approval required) that services were rendered shall be kept in each client
file. Grantee shall maintain all financial and program records for a period of three (3) years from the date
of final payment under this agreement. Grantee shall maintein records on each caregiver served
VII.
including: Family Caregiver In-take Form, Provider Assurance Form (signed and dated) and
ClienUPatient Rights form (signed and dated). The grantee should include their individual
privacy/confidentiality form and a comprehensive intake on the care recipient (see page 2) in
addition to above listed items.
Data Reporting: Grant recipients will keep client information updated in the ARMS systern so we can
submit a bi-annual repoft that will capture required data on caregivers ARMS will capture client
information and report fund usage monthly. The NC Division of Aging and Adult Services and the Cape
Fear Area Agency on Aging will provide training and technical assistance as needed.
Grantees must allow for "consumer contributions" (caregiver must be given opportunity to contribute to
defray the cost of the service, but may not be denied service should he/she fail to or choose not to
contribute). The NC Division of Aging and Adult Services Home and Community Care Block Grant
Service Standards for Consumer Contributions will be followed and a signed/dated provider asstuance form
must be present in each client file. Please review the Consumer Contributions Policy and Procedures at:
http://www.ncdhhs. qov/document/consumer-contributions-policv-and-orocedures
REALLOCATION OF GRANT FUNDS
It is understood and agreed, that in the event that the Grantee's rate of progress on this contract is leading to
underutilization of the funds allocated, and if the Grantee cannot dernonstrate how funds will be fully utilized
during the contract period, then, upon notice to the Grantee, the Corurcil of Governments may decrease the total
compensation to be paid hereunder in order to reallocate funds to other Grantees. Famlly Ceregiver Support
Grant expendltures wiII be reviewed rfter sir months to ensure it is on target If results find that utilizrtion
of funds ls less than 507o, the AAA reserves the right to reduce the original grant amount
VIII. AMENDMENTS AND REPROGRAMMING OF FUNDS
This contract may be modified by written amendment at any time. It is understood and agreed that, in the event
that the amount offunds received from the NC Division of Aging and Adult Services is reduced or increased from
the amount(s) quoted, the Council of Governments may, in tum, decrease or increase the total compensation and
reimbursement to be paid. Such changes, including any increase or decrease in the amount ofthe Grantee's
compensation shall be incorporated in written amendments to this contract and signed by both parties.
IX. MONITORING,AUDITING,AIIDREPORTING
The County agrees to have an annual independent audit in accordance with North Carolina General Statutes, North
Carolina Local Government Commission requirernents, Division of Aging and Adult Services Program Audit
Guide for Aging Services and Federal Office of Budget and Managernent (OMB) Uniform Guidance 2 CFR Part
200.
Community service providers, as specified in paragraph one (l), who are not units oflocal govemment or
otherwise subject to the audit and other reporting requirernents of the Local Govemment Commission are subject
to audit and fiscal reporting requiranents, as stated in NC General Statute 143C-6-22 and 23 and OMB Uniform
Guidance CFR 2 Parl 200, where applicable. Applicable community service providers must send a copy of their
year-end financial statements, and any required audit, to the Area Agency on Aging. Home and Community Care
Block Grant providers are not required to submit Activities and Accomplishments Reports. For-profit corporations
are not subject to the requirernents of OMB Uniform Guidance 2 CFR Part 200, but are subject to NC General
Statute 143C-6-22 and 23 and Yellow Book audit requirernents, where applicable. Federal funds may not be used
to pay for a Single or Yellow Book audit unless it is a federal requirement. State funds will not be used to pay
for a Single or Yellow Book audit ifthe provider receives less than $500,000 in state funds. The Deparhnent of
Health and Human Services will provide confirmation of federal and state expenditures at the close ofthe state
fiscal year. Information on audit and fiscal reporting requirernents can be found at
https://www.ncgrants. eov/NCGrants/Publ icReportsResulations. i sp
The following provides a summary of reporting requirernents under NCGS l43C-6-22 and 23 and OMB
Uniform Guidance 2 CFR Part 200 based upon funding received and expended during the service provider's
fiscal year.
Annual Exoenditures Report Reouired to AAA Allowable Cost for Reoortine
Less than $25,000 in Certification form and State N/A
State or Federal funds Grants Compliance Reporting
<$25,000 (item# 11,
Activities and Accomplishments
does 49! have to be completed)
OR
Audited Financial Staternents in
Compliance with CAO/GAS
(i.e. Yellow Book)
Greater than $25,000 Certification form and Schedule of N/A
and less that $500,000 Grantee Receipts >$25,000 and
in State Funds or Schedule ofReceipts and Expenditures
S750,000 in Federal
Funds
OR
Audited Financial Statements in
Compliance with GAO/GAS
(i.e. Yellow Book)
$500,000 + in State funds Audited Financial Staternent in May use State funds, but
but Federal pass through compliance with GAO/GAS (i.e. not Federal Funds
in an amount less than Yellow Book)
$7s0,000
$500,000+ in State f,rnds Audited Financial Statement in May use State and Federal
and $750,000+ in Federalcompliance with OMB Uniform funds
pass through funds Guidance 2 CFR Part 200
(i.e. Single Audit)
Less than $500,000 in State Audited Financial Statement in May use Federal funds,
funds and $750,000+ in compliance with OMB Uniform but not State funds.
Federal pass through funds Guidanc€ 2 CFR Part
(i.e. Single Audit)
It is further understood that the community service providers are responsible to the Area Agency for claritring any
audit exceptions that may arise from any Area Agency assessment, cormty or community service provider single or
financial audit, or audits conducted by the State or Federal Govemments. In the event that the Area Agency or the
Department of Health and Human Services disallows any expenditure made by the community service provider for
any reason, the County shall promptly repay such funds to the Area Agency once any final appeal is exhausted in
5
accordance with paragaph nine (9). The only exceptions are if the Area Agency on Aging is designated as a
community service provider through the County Funding Plan or, if as a part of a procurement process, the Area
Agency on Aging enters into a contractual agreement for service provision with a provider which is in addition to
the required County Funding Plan formats. In these exceptions, the Area Agency is responsible for any disallowed
costs. The County or Area Agency on Aging can recoup any required payback from the community service
provider in the event that payback is due to a community service provider's failure to meet OMB Uniform
Guidance CFR 2 Part 200, 45 CFR Part 1321 or state eligibility requirements as specified in policy.
Representatives of the Council of Governments and the NC Division of Aging and Adult Services may at any
reasonable times review and inspect the service activities and data collected pursuant to this Agreernent. All
reports and computations prepared by or for the Grantee shall be made available to authorized representatives of
the Council of Govemments, and the NC Division of Aging and Adult Services for inspection and review at any
reasonable time in the Grantee's office. Approval and acceptance ofsuch material shall not relieve the Grantee of
its professional obligation to discover and correct, at its expense, any errors found in the work.
To ensure adequate review and evaluation of the work and proper coordination among interested parties, the
Council of Govemments shall be kept fully informed conceming the progress of the work and services to be
performed.
Council of Governments staffwill conduct on-site assessments and may also make unannounced visits for the
purpose ofevaluating the Grantee's work.
x. CoMPLIAI\CE WITH TITLE Vr & VIII OF CM RIGHTS ACT, SECTION 504 OF THE
REHABILITATION ACT, AND AMERICANS WITH DISABILITIES ACT
The Grantee shall comply with Title VI and VIII of the Civil Rights Act of 1964, Section 504 of the Rehabilitation
Act of 1973, and the Americans with Disabilities Act of 1990 (ADA) and all requirernents imposed by Federal
regulations, rules and guidelines issued pursuant to these Titles and the ADA for both personnel employed and
clients served.
XI. CONFLICT OF INTEREST
The Grantee expressly states that presently they have no interest and shall not acquire any interest, direct or
indirect, which would conflict in any manner or degree with the performance ofservices required to be performed
under this contract. The Gmntee shall not employ any person having such interest during the performance of this
contract. The Grantee further agrees to notiry the fuqA in writing of any instance that might have the appearance
of a conflict of interest. See Attachment A for signature
XII. CONFIDENTIALITY
Any reports, recipient information, data, or other materials given to or prepared or assembled by the Grantee under
this Agreanent which the Council of Govemments requests to be kept confidential shall not be made available to
any individual or organization by the Grantee without prior written approval ofthe Council of Govemments.
XIII. INDEMNITY
Grantee shall indemniff and hold the Cape Fear Council of Govemments, its agents and anployees, harmless
against any and all claims, demands, causes ofaction, or other liability, including attomey fees, on account of
personal injuries or death or an account of property damages arising out ofor relating to the work to be performed
by the Grantee hereunder, resulting from the negligence ofor the willful act of omission ofthe Grantee, their
agents, employees, and subcontractors.
6
XIV. ATTENDANCE AT REGION O AREA AGENCY ON AGING MEETINGS
The Grantee, upon request of the AAA Administrator/Designee, will make efforts to attend any committee or
special meeting relating to the project. The Grantee will attend any scheduled regional Family Caregiver Support
Program meetings.
XV. TERMINATION OFAGREEMENT FOR CAUSE
If through any cause, the Grantee shall fail to fulfill in timely and proper manner its obligations under this
Agreement or if the Grantee shall violate any of the covenant, agreements or stipulations of this Agreement, the
Council of Govemments shall thereupon have the right to terminate this Agreement by giving written notice to the
Grantee of such termination and speciflng the effective date thereof. The date ofnotice shall be at least fifteen
( 15) days before the effective date ofsuch termination.
The Grantee shall have the right to terminate this Agreement by giving the Council of Govemments written notice
of such termination at least fifteen ( I 5) days prior to the effective date of the termination. In such event, all
finished documents and other materials collected or produced under this Agreanent shall, at the option of the
Council of Govemments, become its property.
The Grantee shall be entitled to receive just and equitable compensation for any work satisfactorily performed
under this Agreement.
XVI. APPROVAL OFSUBCONRACTORORASSIGNABILITY
Ifthe Grantee records show that they have negotiated/arranged for any of the service categories to be provided by a
goverrunent or not-for-profit organization it must be with a clearly defined contract and/or agreement. If the
Grantee chooses to contract for any ofthe service categories with a for-profit agency, records must show that they
have followed the reference regulation regarding bidding and awarding of federal funds, if applicable.
(Contracting for the FCSP is allowed with private for-profit agencies without bidding out the contracts provided
that the contract is for $25,000 or less. The conhactor may use local bidding procedures that are not in conflict
with the referenced federal guidelines. The price negotiated should be reasonable with fair market value. [DHHS
regulations 45 CFR, Part 92.36.1)
XVII. TAX EXEMPT STATUS
If grantee has tax exempt status they must submit a copy of the tax exempt declaration letter with contract.
,7
IN WITNESS THEREOF, THE COUNCIL OF GOVERNMENTS AIID TIIE GRANTEE IIAVE
f,XECUTED THIS AGREEMENT AS OF TIIE DATE FIRST WRITTEN ABOVE.
('.4 P?_ rE 1R ('OtrI',(', _ ()F GOt t/t \.1/t \ 7.t:
Executive Director Date
Area Agency on Aging Administrator Date
This instrument has been preaudited in the manner required by the local government budget and fiscal
control act.
Finance Officer
GRANTEE: New Hanover County Senior Resource Center
Irr,l
By:
Lead Agency Oflicial
, Ad<r, \,1n*f C*,\,tlc'r*3"r
Attachmenl A
CONFLICT OF INTEREST POLICY
In accordance with G.S. 143-6.1 and related legislation, we, the undersigned entity, have
adopted the following policy regarding conflicts ofinterest:
The undersigned entity is aware that in the process of fund allocation by its
management, employees, mernbsrs ofthe board of directors or other governing
body, instances may arise which have the appearance of a conflict of interest or
appearance of impropriety.
In order to avoid conflicts of interest or the appearance of impropriety, should
instances arise where a conflict may be perceived, any individual who may
benefit, directly or indirectly, from the entity's disbursernent offunds shall abstain
from participating in any decisions or deliberation by the entity regarding the
di sbursernent of funds.
The undersigned entity recognizes the possibility that it may be the recipient of
funds which are allocated consistent with the purpose and goals of its programs.
Ifsuch allocations are made, the undersigned entity will strive to ensure that funds
are expended in such a manner that no individual will benefit, directly or
indirectly, from the expenditure ofsuch funds in a manner inconsistent with its
proglams.
Swom to and subscribed before me.
rhisthe ?ff a.r"f
-S*-,IDIL.
My Commission expt.es: o B lO< I XoLo
- other Authorized OfficialA{t,\ 111\. P,no\er, D+dX Gu4\ftitonayf